64794D - Sewell

===
lmmm

wrn aoiuc v�ucm�a oann v..w rav�.w yr 9761
acc
9/17/2015 Francis and Ann Prior same PNC Bank 720 $200.00 GP 66105D

4C Division of Coastal Mgt. Habitat Impact Computer Sheet
kpplicant: J Permit #:
)ate:
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
Fund in your Habitat code sheet.
labitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated fin
disturbance.
Excludes any
restoration and,
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
O
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

WNW
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
ly Eaves Perdue Braxton C. Davis
nor Director
AGENT AUTHORIZATION FORM
Date:
of Property Owner Applying for Permit:
11 sevUCI\ _
's Mailin Address:
CA A/kJ talc_
Number f/ 4/ 3 2 G
Dee Freeman
Secretary
N me of Authoriz d Agent for this project:
mblq
Agent's Mailing Address:
�1 S00\ Vi ��
t✓
Phone Number (q ) o) oz
r that I have authorized the agent listed above to act on my behalf, for the purpose of applying
obtaining all CAMA Permits necessary to install or construct the following (activity):
I property located at PLI t( -'V`
.Ttification is valid thru (date) _
Signed by:
SuAla 8/30/2015
'3AD6456456...
Property Owner Signature Date

US MAIL
CERTIFIED MAIL, — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: \ 1 SLyi eA
Address of Property: I . ��_ tCU-A
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: �/ % y4 f 3 7 �e ) _ Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
has described to me as shown on the attached drawing the development they are proposing. A description of drawin
with dimensions, must be provided with this letter.
&L-xi have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
appropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signature
Print or Type Name A
q e, . ) , --
Mailing Address
DUAL T-ISUL"I NC aK45�-�
(pit-, /.-'tat,- / 7in
(Riparian Property Owner Information)
Signature
vuava 0J(%eYQCCV1
Print or Name
Mailing Address1�710V-nkv�wfj
L �)
('itv / gt;tp / 7in

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we -can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
✓ ,Y -4 (�� e►'5 �
2_ Article Number
(Transfer from service /abeq
A. Signature
X �.`� :
B. Received (Pn'nt Name) C. d
Pd
V 7
D. Is delivery address different from item 17 _Yes
It YES, enter delivery address be3ow: C No
3. Service Type
KCertified MailO ❑ Priority Mail Egress"
❑ Registered ❑ Retum Receipt for Merchan6se
❑ Insured Mail ❑ Collect on Delivery
4. Rest:ctEd Delivery? (Extra Fee) 0 Yes
Ps Form 3811, July 2013 Domestic Return Receipt
4

-!'ID DELIVER
ADJACENT RIPARIAsN PROPERTY OWNER STATEMENT
(FOR A PIERIMOO t.ING PILINGSaNTLIFTBOATHOUSE)
ehy certify that I own property adjacent toti'
(Name of Property Owner)
cv
-ny located at -
(Lot, Block, Road, etc.)
on �
N.C.
(Waterbody) �~ ( own and/or County)
Applicant's phone !t: _` Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. 1 understand that a pier/mooring pilings 1 boatlift 1 boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
U--- I do not wish to waive
1 do Evish to waive that setback requirement.
DESCRIPTION ANDIOR MR WING OF PROPOSED DEVELOPMENT:
(To be filled in by individctal proposing development)

WATER
STEPS

i
V, 0a
v -
I
l
PROPERTY OF ,Q% / / f I/✓L- �' PROPERTY OF